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Systems: Reproduction AB > Antenatal Care and Screening > Flashcards

Antenatal Care and Screening Flashcards

1
Q

How common is morning sickness?

A

Affects 80-85% of women

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2
Q

When is morning sickness worse?

A
  • Early in pregnancy

- Conditions where BHCG is higher (twins, molar pregnanct etc.)

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3
Q

What can morning sickness progress to?

A

Hyperemesis gravidarum

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4
Q

How can morning sickness be managed?

A

Sometimes requires rehydration therapies and steroids

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5
Q

How does pregnancy affect cardiac output?

A
  • Increases by 30-50%
  • Heart rate increase from 70-90bpm
  • Palpitations are common
  • At term blood flow to the uterus must exceed 1L per minute
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6
Q

Why does BP drop in the 2nd trimester?

A
  • Expansion of the uteroplacental circulation
  • A fall in systemic vascular resistance
  • A reduction in blood viscosity
  • A reduction in sensitivity to angiotensin
  • BP usually returns to normal in the third trimester
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7
Q

How does pregnancy affect urine output?

A
  • Increased urine output
  • Renal plasma flow increases by 25-50%
  • GFR increases by 50%
  • Serum urea and creatinine decreases
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8
Q

Why are UTIs more common in pregnancy?

A
  • There is an increase in urinary stasis (less chance of the bladder completely voiding)
  • Hydronephrosis is physiological in the third trimester and makes pyelonephritis more common
  • Can be associated with preterm labour so important to treat
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9
Q

What haematological changes occur during pregnancy?

A
  • Physiological anaemia
  • Plasma volume increases by about 50% and RBC mass by about 25%
  • Drop in haemoglobin by dilution from 133-121g/L
  • Iron requirements are increased by 1g during pregnancy
  • WBC increase slightly to 9000-12,000/uL
  • Platelet count falls by dilution
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10
Q

What respiratory changes occur during pregnancy?

A

Progesterone acts centrally to reduce CO2

  • Increases tidal volume
  • Increases respiratory rate
  • Increases plasma pH
  • O2 consumption increase by 20%
  • Plasma PO2 is unchanged
  • Hyperaemia of respiratory mucous membranes
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11
Q

What GI changes occur during pregnancy?

A
  • Oesophageal peristalsis is reduced
  • Gastric emptying sloes
  • Cardiac sphincter relaxes
  • GI motility is reduced due to increased progesterone and decreased motilin
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12
Q

Ideally, who should receive pre-pregnancy counselling?

A

All women

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13
Q

What are the top 5 causes of maternal death?

A
  • Cardiac disease
  • Sepsis
  • Thrombosis
  • Neurological
  • Psychiatric
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14
Q

What is involved in pre-pregnancy counselling?

A
  • Improve diet
  • Optimise BMI
  • Reduce alcohol intake
  • Smoking cessation
  • Folic acid
  • Confirm immunity to rubella
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15
Q

How should folic acid be taken?

A
  • 400mcg
  • Advised to start 3 months before conception
  • Can significantly reduce the risk of neural tube defects
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16
Q

What is involved inn pre-pregnancy counselling for known medical problems?

A
  • Optimise maternal health
  • Psychiatric health is important
  • Stop/Change any unsuitable drugs
  • Advise regarding complications associated with maternal medical problems
  • Occasionally advise against pregnancy
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17
Q

What maternal previous pregnancy problems should be addressed in pre-pregnancy counselling?

A
  • Counsel regarding risk of recurrence
  • Caesarean Section
  • DVT
  • Pre-eclampsia (aspirin)
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18
Q

What actions can reduce maternal complications?

A
  • Thromboprophylaxis

- Low dose aspirin

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19
Q

What foetal previous pregnancy problems should be addressed in pre-pregnancy counselling?

A

Counsel regarding risk of recurrence

  • Pre-term delivery
  • Intrauterine growth restriction
  • Foetal abnormality
20
Q

What actions can reduce foetal complications?

A
  • Treatment of infection
  • High dose folic acid
  • Low dose aspirin
21
Q

Why is antenatal examination carried out?

A

High quality antenatal care reduced foetal and maternal mortality by identifying problems

22
Q

What problems can be identified in the antenatal examination?

A

Mother

  • Problems such as pre-existing or developing illness
  • ‘Minor’ problems of pregnancy such as anaemia

Foetus

  • Small for gestational age
  • Foetal abnormality

Social

  • Support
  • Domestic violence
  • Psychiatric Illness
23
Q

What is involved in the antenatal examination?

A
  • Routine enquiry
  • Blood pressure
  • Urinalysis
  • Abdominal palpation
  • Determine foetal lie
  • Listen to foetal heartbeat
24
Q

Why is abdominal palpation carried out?

A
  • Assess symphyseal fundal height (SFH)
  • Estimate size of baby
  • Estimate liquor volume
25
Q

What does antenatal screening allow?

A

Allows conditions to be detected early in a symptomless population to be treated for mother/baby

26
Q

What infections are screened for in pregnancy?

A
  • Hepatitis B (can provide passive and active immunisation for baby)
  • Syphilis (easily treated with penicillin)
  • HIV (vertical transmission can be reduced)
  • UTI (by MSSU)
  • Rubella
27
Q

How can congenital rubella syndrome present?

A
  • Mental handicap
  • Blindness
  • Deafness
  • Heart defects
28
Q

What does congenital syphilis cause?

A
  • IUGR
  • Hepato-splenomegaly
  • Anaemia
  • Thrombocytopenia
  • Skin rashes
29
Q

What haematological screening is carried out?

A
  • Screen for iron deficiency anaemia

- Isoimmunisation including Rhesus disease, anti-C and anti-kell

30
Q

What is rhesus disease?

A
  • Rhesus negative mum has rhesus positive baby.
  • Mum develops anti-D antibodies
  • Sensitising event
  • Subsequent pregnancy mum’s antibodies will cross the placenta and attack rhesus positive baby
31
Q

What is the purpose of the first ultrasound scan?

A
  • Ensure pregnancy viable
  • Multiple pregnancy
  • Identify abnormalities incompatible with life
  • Offer and carry out Down’s syndrome screening
32
Q

What is a detailed anomaly scan?

A
  • Systematic structural review of baby
  • Not possible to identify all problems
  • Can identify problems that need intrauterine or postnatal treatment
33
Q

What is Down syndrome?

A

Down Syndrome is a chromosomal abnormality characterised by 3 copies of chromosome 21

34
Q

What is the overall risk of Down syndrome?

A

1 in 700

35
Q

What are some risk factors for Down syndrome?

A
  • Increasing maternal age

- Personal or family history of chromosomal abnormality

36
Q

What must parents be aware of before screening for Down syndrome?

A

Women and their partners must be aware prior to any screening taking place that tests for foetal abnormality only provide a risk of their baby being affected.

37
Q

What first trimester screening for Down syndrome is there?

A
  • Carried out at 10 -14 weeks gestation
  • Uses maternal risk factors, serum -human chorionic gonadotrophin (-hCG) and pregnancy associated plasma protein A (PAPP-A) and fetal nuchal translucency (NT) measurement
  • Detection rate for Trisomy 21 of ~90%, invasive testing rate of 5%
38
Q

Where are nuchal translucency measurements taken from?

A

Between the crown and the rump lengths of 45-84mm

39
Q

When does nuchal translucency increase?

A

Nuchal translucency increases with gestational age
and the incidence of chromosomal and other
abnormalities is related to the size, rather than the
appearance of NT.

40
Q

What happens with a high risk NT result for Down syndrome?

A
  • Further testing is offered if risk of Down’s syndrome is >1 in 150
  • CVS
  • Amniocentesis
  • Non-invasive prenatal testing
41
Q

When is CVS carried out?

A
  • Between weeks 10 and 14

- 1-2% risk of miscarriage

42
Q

When is amniocentesis carried out?

A
  • Week 15 onwards

- ~1% risk of miscarriage

43
Q

How is non-invasive prenatal testing carried out?

A
  • Maternal blood taken
  • Can detect fetal cell free DNA
  • Can look for chromosomal trisomies
  • Not offered on NHS
  • If high risk, still recommended to have invasive testing to confirm
44
Q

What should those at high risk of neural tube defects be advised?

A

5mg of folic acid to reduce risk

45
Q

How can neural tube defects be screened for?

A

-Not routinely offered since introduction of first trimester screening
-First trimester ultrasound to detect anencephaly and sometimes spina bifida (variants of NTD)
-Second trimester biochemical screening(carried out if not able to get NT measurement,
Maternal serum is tested for alpha fetoprotein, >2.0MoM is high risk and warrants investigation)
-Second trimester (20 week) ultrasound will detect >90% of NTD

46
Q

What is the purpose of the 2nd trimester ultrasound?

A
  • To detect foetal abnormality

- Good test for major structural abnormalities but not chromosomal abnormalities

Systems: Reproduction AB (35 decks)

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